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Arnold TC, Kini LG, Bernabei JM, Revell AY, Das SR, Stein JM, Lucas TH, Englot DJ, Morgan VL, Litt B, Davis KA. Remote effects of temporal lobe epilepsy surgery: Long-term morphological changes after surgical resection. Epilepsia Open 2023; 8:559-570. [PMID: 36944585 PMCID: PMC10235552 DOI: 10.1002/epi4.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE Epilepsy surgery is an effective treatment for drug-resistant patients. However, how different surgical approaches affect long-term brain structure remains poorly characterized. Here, we present a semiautomated method for quantifying structural changes after epilepsy surgery and compare the remote structural effects of two approaches, anterior temporal lobectomy (ATL), and selective amygdalohippocampectomy (SAH). METHODS We studied 36 temporal lobe epilepsy patients who underwent resective surgery (ATL = 22, SAH = 14). All patients received same-scanner MR imaging preoperatively and postoperatively (mean 2 years). To analyze postoperative structural changes, we segmented the resection zone and modified the Advanced Normalization Tools (ANTs) longitudinal cortical pipeline to account for resections. We compared global and regional annualized cortical thinning between surgical treatments. RESULTS Across procedures, there was significant cortical thinning in the ipsilateral insula, fusiform, pericalcarine, and several temporal lobe regions outside the resection zone as well as the contralateral hippocampus. Additionally, increased postoperative cortical thickness was seen in the supramarginal gyrus. Patients treated with ATL exhibited greater annualized cortical thinning compared with SAH cases (ATL: -0.08 ± 0.11 mm per year, SAH: -0.01 ± 0.02 mm per year, t = 2.99, P = 0.006). There were focal postoperative differences between the two treatment groups in the ipsilateral insula (P = 0.039, corrected). Annualized cortical thinning rates correlated with preoperative cortical thickness (r = 0.60, P < 0.001) and had weaker associations with age at surgery (r = -0.33, P = 0.051) and disease duration (r = -0.42, P = 0.058). SIGNIFICANCE Our evidence suggests that selective procedures are associated with less cortical thinning and that earlier surgical intervention may reduce long-term impacts on brain structure.
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Affiliation(s)
- T. Campbell Arnold
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lohith G. Kini
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John M. Bernabei
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew Y. Revell
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neuroscience, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sandhitsu R. Das
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joel M. Stein
- Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Timothy H. Lucas
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurosurgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dario J. Englot
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Victoria L. Morgan
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brian Litt
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kathryn A. Davis
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Barkley AS, Sullivan LT, Gibson AW, Zalewski K, Mac Donald CL, Barber JK, Hakimian S, Ko AL, Ojemann JG, Hauptman JS. Acute Postoperative Seizures and Engel Class Outcome at 1 Year Postselective Laser Amygdalohippocampal Ablation for Mesial Temporal Lobe Epilepsy. Neurosurgery 2022; 91:347-354. [PMID: 35506941 DOI: 10.1227/neu.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy is a safe, minimally invasive alternative to traditional surgical approaches. Prognostic factors associated with efficacy are debated; preoperative epilepsy duration and semiology seem to be important variables. OBJECTIVE To determine whether acute postoperative seizure (APOS) after MRgLITT for mesial temporal lobe epilepsy is associated with seizure freedom/Engel class outcome at 1 year. METHODS A single-institution retrospective study including adults undergoing first time MRgLITT for mesial temporal lobe epilepsy (2010-2019) with ≥1-year follow-up. Preoperative data included sex, epilepsy duration, number of antiepileptics attempted, weekly seizure frequency, seizure semiology, and radiographically verified anatomic lesion at seizure focus. Postoperative data included clinical detection of APOS within 7 days postoperatively, and immediate amygdala, hippocampal, entorhinal, and parahippocampal residual volumes determined using quantitative imaging postprocessing. Primary outcome was seizure freedom/Engel classification 1 year postoperatively. RESULTS Of 116 patients, 53% (n = 61) were female, with an average epilepsy duration of 21 (±14) years, average 6 failed antiepileptics (±3), and weekly seizure frequency of 5. APOS was associated with worse Engel class (P = .010), conferring 6.3 times greater odds of having no improvement vs achieving seizure freedom at 1 year. Residual amygdala, hippocampal, entorhinal, and parahippocampal volumes were not statistically significant prognostic factors. CONCLUSION APOS was associated with a lower chance of seizure freedom at 1 year post-MRgLITT for mesial temporal lobe epilepsy. Amygdala, hippocampal, entorhinal, and parahippocampal residual volumes after ablation were not significant prognostic factors.
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Affiliation(s)
- Ariana S Barkley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Liam T Sullivan
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Alec W Gibson
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Shahin Hakimian
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
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Shah P, Bernabei JM, Kini LG, Ashourvan A, Boccanfuso J, Archer R, Oechsel K, Das SR, Stein JM, Lucas TH, Bassett DS, Davis KA, Litt B. High interictal connectivity within the resection zone is associated with favorable post-surgical outcomes in focal epilepsy patients. NEUROIMAGE-CLINICAL 2019; 23:101908. [PMID: 31491812 PMCID: PMC6617333 DOI: 10.1016/j.nicl.2019.101908] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 01/21/2023]
Abstract
Patients with drug-resistant focal epilepsy are often candidates for invasive surgical therapies. In these patients, it is necessary to accurately localize seizure generators to ensure seizure freedom following intervention. While intracranial electroencephalography (iEEG) is the gold standard for mapping networks for surgery, this approach requires inducing and recording seizures, which may cause patient morbidity. The goal of this study is to evaluate the utility of mapping interictal (non-seizure) iEEG networks to identify targets for surgical treatment. We analyze interictal iEEG recordings and neuroimaging from 27 focal epilepsy patients treated via surgical resection. We generate interictal functional networks by calculating pairwise correlation of iEEG signals across different frequency bands. Using image coregistration and segmentation, we identify electrodes falling within surgically resected tissue (i.e. the resection zone), and compute node-level and edge-level synchrony in relation to the resection zone. We further associate these metrics with post-surgical outcomes. Greater overlap between resected electrodes and highly synchronous electrodes is associated with favorable post-surgical outcomes. Additionally, good-outcome patients have significantly higher connectivity localized within the resection zone compared to those with poorer postoperative seizure control. This finding persists following normalization by a spatially-constrained null model. This study suggests that spatially-informed interictal network synchrony measures can distinguish between good and poor post-surgical outcomes. By capturing clinically-relevant information during interictal periods, our method may ultimately reduce the need for prolonged invasive implants and provide insights into the pathophysiology of an epileptic brain. We discuss next steps for translating these findings into a prospectively useful clinical tool. We analyze interictal iEEG recordings and neuroimaging from epilepsy patients We find that high interictal strength selectivity is associated with better outcomes This effect appears to be driven largely by connectivity within the resection zone Interictal recordings can guide identification of seizure-generating networks
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Affiliation(s)
- Preya Shah
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - John M Bernabei
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lohith G Kini
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Arian Ashourvan
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jacqueline Boccanfuso
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ryan Archer
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kelly Oechsel
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sandhitsu R Das
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joel M Stein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Timothy H Lucas
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Danielle S Bassett
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Electrical & Systems Engineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Physics & Astronomy, College of Arts & Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kathryn A Davis
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Litt
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Grewal SS, Zimmerman RS, Worrell G, Brinkmann BH, Tatum WO, Crepeau AZ, Woodrum DA, Gorny KR, Felmlee JP, Watson RE, Hoxworth JM, Gupta V, Vibhute P, Trenerry MR, Kaufmann TJ, Marsh WR, Wharen RE, Van Gompel JJ. Laser ablation for mesial temporal epilepsy: a multi-site, single institutional series. J Neurosurg 2019; 130:2055-2062. [PMID: 29979119 DOI: 10.3171/2018.2.jns171873] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although it is still early in its application, laser interstitial thermal therapy (LiTT) has increasingly been employed as a surgical option for patients with mesial temporal lobe epilepsy. This study aimed to describe mesial temporal lobe ablation volumes and seizure outcomes following LiTT across the Mayo Clinic's 3 epilepsy surgery centers. METHODS This was a multi-site, single-institution, retrospective review of seizure outcomes and ablation volumes following LiTT for medically intractable mesial temporal lobe epilepsy between October 2011 and October 2015. Pre-ablation and post-ablation follow-up volumes of the hippocampus were measured using FreeSurfer, and the volume of ablated tissue was also measured on intraoperative MRI using a supervised spline-based edge detection algorithm. To determine seizure outcomes, results were compared between those patients who were seizure free and those who continued to experience seizures. RESULTS There were 23 patients who underwent mesial temporal LiTT within the study period. Fifteen patients (65%) had left-sided procedures. The median follow-up was 34 months (range 12-70 months). The mean ablation volume was 6888 mm3. Median hippocampal ablation was 65%, with a median amygdala ablation of 43%. At last follow-up, 11 (48%) of these patients were seizure free. There was no correlation between ablation volume and seizure freedom (p = 0.69). There was also no correlation between percent ablation of the amygdala (p = 0.28) or hippocampus (p = 0.82) and seizure outcomes. Twelve patients underwent formal testing with computational visual fields. Visual field changes were seen in 67% of patients who underwent testing. Comparing the 5 patients with clinically noticeable visual field deficits to the rest of the cohort showed no significant difference in ablation volume between those patients with visual field deficits and those without (p = 0.94). There were 11 patients with follow-up neuropsychological testing. Within this group, verbal learning retention was 76% in the patients with left-sided procedures and 89% in those with right-sided procedures. CONCLUSIONS In this study, there was no significant correlation between the ablation volume after LiTT and seizure outcomes. Visual field deficits were common in formally tested patients, much as in patients treated with open temporal lobectomy. Further studies are required to determine the role of amygdalohippocampal ablation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Vivek Gupta
- 9Radiology, Mayo Clinic, Jacksonville, Florida
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Shamim S, Wiggs E, Heiss J, Sato S, Liew C, Solomon J, Theodore WH. Temporal lobectomy: resection volume, neuropsychological effects, and seizure outcome. Epilepsy Behav 2009; 16:311-4. [PMID: 19703792 PMCID: PMC2785019 DOI: 10.1016/j.yebeh.2009.07.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 07/15/2009] [Accepted: 07/26/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of the work described here was to evaluate relationships among resection volume, seizure outcome, and cognitive morbidity after temporal lobectomy for intractable epilepsy. METHODS Thirty patients with mesial temporal sclerosis were evaluated pre- and postoperatively with the Wechsler Adult Intelligence Scale III, Wechsler Memory Scale III, and three-dimensional coronal spoiled gradient recall acquisition MRI. Preoperative whole-brain volumes were calculated with Statistical Parametric Mapping. Resection volume was calculated by manual tracing. Systat was used for statistical analysis. RESULTS All resections included the temporal tip, at least 1cm of the superior temporal gyrus, and 3 to 5cm of the middle and inferior temporal gyri. Left were significantly smaller than right temporal resections. Seizure-free patients had significantly larger resections. Immediate verbal memory was significantly worse after left temporal lobectomy. Surgical outcome and resection volume did not affect postoperative neuropsychological results. CONCLUSIONS Dominant temporal lobe resections are associated with immediate verbal memory deficits. Larger resection volume was associated with improved seizure control but not worse cognitive outcome.
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Affiliation(s)
- Sadat Shamim
- Clinical Epilepsy Section, NINDS, NIH, Bethesda, MD 20892-1408
| | - Edythe Wiggs
- Office of the Clinical Director, NINDS, NIH, Bethesda, MD 20892-1404
| | - John Heiss
- Surgical Neurology Branch, NINDS, NIH, Bethesda, MD 20892-1414
| | - Susumu Sato
- EEG Section, OCD, NINDS, NIH, Bethesda, MD 20892-1404
| | - Clarissa Liew
- Clinical Epilepsy Section, NINDS, NIH, Bethesda, MD 20892-1408., EEG Section, OCD, NINDS, NIH, Bethesda, MD 20892-1404
| | - Jeffrey Solomon
- Medical Numerics 20410 Observation Drive Suite 210 Germantown, MD 20876
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